A list of the most recent deficiencies for Morning Star Post Acute. The list is based on the information provided by CMS from both standard inspections and from complaints filed by residents.
| Deficiency | Type of Deficiency | Deficiency Date | Date Corrected | Resulted from a Complaint? |
|---|---|---|---|---|
| Honor the resident's right to share a room with spouse or roommate of choice and receive written notice before a change is made. | Health | 2023-11-09 | 2023-12-28 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2023-11-09 | 2023-12-28 | N |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2023-11-09 | 2023-12-28 | N |
| Provide enough food/fluids to maintain a resident's health. | Health | 2023-11-09 | 2023-12-28 | N |
| Provide safe, appropriate pain management for a resident who requires such services. | Health | 2023-11-09 | 2023-12-28 | N |
| Provide safe, appropriate dialysis care/services for a resident who requires such services. | Health | 2023-11-09 | 2023-12-28 | N |
| Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. | Health | 2023-11-09 | 2023-12-28 | N |
| Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service. | Health | 2023-11-09 | 2023-12-28 | N |
| Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. | Health | 2023-11-09 | 2023-12-28 | N |
| Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. | Health | 2023-11-09 | 2023-12-28 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2023-11-09 | 2023-12-28 | N |
| Dispose of garbage and refuse properly. | Health | 2023-11-09 | 2023-12-28 | N |
| Provide and implement an infection prevention and control program. | Health | 2023-11-09 | 2023-12-28 | N |
| Ensure resident rooms hold no more than 4 residents; for new construction after November 28, 2016, rooms hold no more than 2 residents. | Health | 2023-11-09 | 2023-12-28 | N |
| Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. | Health | 2023-11-09 | 2023-12-28 | N |
| Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. | Health | 2023-11-09 | 2023-12-28 | N |
| Conduct risk assessment and an All-Hazards approach. | Fire Safety | 2023-11-14 | 2023-11-21 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2023-11-14 | 2023-11-21 | N |
| Properly select, install, inspect, or maintain portable fire extinguishes. | Fire Safety | 2023-11-14 | 2023-11-21 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2023-11-14 | 2023-11-21 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2023-11-14 | 2023-11-21 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2023-09-13 | 2023-10-04 | N |
| Provide and implement an infection prevention and control program. | Health | 2023-09-13 | 2023-10-04 | N |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2023-02-24 | 2023-03-03 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2022-12-14 | 2023-02-20 | Y |
| Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted | Health | 2022-05-19 | 2022-06-16 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2022-05-19 | 2022-06-16 | N |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2022-05-19 | 2022-06-16 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2022-05-19 | 2022-06-16 | N |
| Provide enough food/fluids to maintain a resident's health. | Health | 2022-05-19 | 2022-06-16 | N |
| Ensure each resident?s drug regimen must be free from unnecessary drugs. | Health | 2022-05-19 | 2022-06-16 | N |
| Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. | Health | 2022-05-19 | 2022-06-16 | N |
| Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. | Health | 2022-05-19 | 2022-06-16 | N |
| Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service. | Health | 2022-05-19 | 2022-06-16 | N |
| Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. | Health | 2022-05-19 | 2022-06-16 | N |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2022-05-19 | 2022-06-16 | N |
| Provide and implement an infection prevention and control program. | Health | 2022-05-19 | 2022-06-16 | N |
| Ensure resident rooms hold no more than 4 residents; for new construction after November 28, 2016, rooms hold no more than 2 residents. | Health | 2022-05-19 | 2022-06-16 | N |
| Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector. | Fire Safety | 2022-05-23 | 2022-06-06 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2022-05-23 | 2022-06-06 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2022-05-23 | 2022-06-06 | N |
| Properly select, install, inspect, or maintain portable fire extinguishes. | Fire Safety | 2022-05-23 | 2022-06-06 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2022-05-23 | 2022-06-06 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2022-05-23 | 2022-06-06 | N |
| Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. | Health | 2022-03-17 | 2022-04-19 | Y |
| Conduct testing and exercise requirements. | Fire Safety | 2019-07-11 | 2019-08-02 | N |
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2019-07-11 | 2019-08-02 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2019-07-11 | 2019-08-02 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2019-07-11 | 2019-08-02 | N |
| Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. | Health | 2019-06-13 | 2019-07-24 | N |
| Ensure resident rooms hold no more than 4 residents; for new construction after November 28, 2016, rooms hold no more than 2 residents. | Health | 2019-06-13 | 2019-07-24 | N |
